Voices From the Frontline: Q&A with Nurse Dinah Leal

Dinah - Covid

Q: Could tell us a bit more about what’s the situation in your hospital and how you’ve been involved with the COVID-19 response?

A: “I work in one of the largest teaching hospitals in Europe and we’ve been involved in the frontline response to COVID-19 from the start, because we’re the primary hospital for COVID admissions for our region. As a member of the perioperative team, I was directly involved in the reassigning of our operating theatres, as ICU, overflow pods for patients requiring critical care. So we were responsible for the reconfiguration of the theatres and the staffing of the new area in supporting the critical care steps.”

Q: How has being involved with Operation Smile helped prepare you for responding to the COVID-19 pandemic?

A: “My involvement with Operation Smile helped in so many ways. In particular, it helped us with the building of the new clinical areas such as the operating theatres, all the skills were used in Operation Smile, preparing for the missions, that gave me the skills for the planning and reassigning of the new clinical areas. The skills developed in team working were invaluable in this situation, which helped with the reconfiguration of the critical care areas in a hurry.  And also the communication and the teamwork. Well, you have to be very clear about reassigning tasks and what you want to achieve and working in a logical and efficient manner to build a new area that works for the new purpose. It was a wonderful experience and I really enjoyed.”

Q: What kind of limitations have you and other members of your team faced?

DL: Well, we faced a lot of challenges and limitations. But first of all, we were particularly challenged by the time factor because we were expecting a surge in critical care needs to arrive very suddenly, possibly overwhelmingly. So we were really challenged to prepare very quickly.

Similarly to an Operation Smile situation where we have to really be ready in a couple of days. And sometimes we can be delayed by lack of cargo, or delays in cargo. But still, we have to be ready to start surgery on the Monday morning. Here in our situation, we needed to be ready to provide critical care very quickly.

The next serious challenge we faced was the equipment. We were very low. There was a nationwide shortage of equipment, especially ventilators and oxygen delivery equipment. But between the team and the biomedical team, we were able to work together and we quickly managed to overcome this and more than doubled our capacity for critical care in a few days. It was challenging but it was very exciting to be part of it and see how it worked.

As the situation progressed, we were then challenged by the shortage of PPE, that was the next big challenge for the country and for us on the frontline, that meant that we had to be really careful about what we used. And we had to make sure that we didn’t use equipment that other staff would need more so than us. We had to be very careful and select the appropriate one to the task and be very mindful of waste and, you know, looking after our colleagues, because it was a very, very real possibility that we could run out at any time. We did get very low on a couple of occasions early on in the crisis but we were able to get by just by judicious use of it really.

Q: In light of this pandemic, why do you feel it’s so important to recognise nurses and the role they serve in the medical field?

A: Well, nurses have been rightly recognised as playing a critical role in the response to COVID-19. And I think their importance in the frontline was really recognised.

They are a vital part of the team response with their ability to support their medical colleagues and provide the caring and the hands-on skills which have been an intrinsic and essential part of patient recovery.

The role of nurses has been even more important because they had to play the role of the family, due to the infectious nature of the disease. In many cases, the enormous responsibility of supporting the patient at the end of life has become one of the most vital nursing roles, which normally the family would do alone.

So it’s been particularly poignant to see the role of nurses here, and some of the stories that have come from the ICU are very moving and very, very sad because so many patients have died without their family and it’s been terribly difficult to manage. So the role of nurses in that respect has been really important.

It brings to mind the importance of our role in Operation Smile missions, where the nurses are the ones who are entrusted with the safety and care of the children on behalf of their parents. That responsibility, and the honour and privilege we have playing that role when these parents hand their children over for surgeries, brings home how important this role is. It is not only a clinical role. It’s a real, real caring role.

Q: Did you feel prepared, like psychologically prepared or did you receive any support for that? Because I know that it can be very hard to process all of this.

A: Well, my exposure to the situation has been very limited because I work in the operating theatre. I know my colleagues have found it extremely difficult. The hospital has provided a lot of support, but it remains to be seen whether that’s been enough. As colleagues, we can provide support to each other and nurses are really good at doing that.

In the early days, I felt very strongly as one of the senior members of staff, that supporting the younger staff was really important, and really listening to them and being there for them. Another role was really important for us senior nurses, particularly, because in our hospital, they sent the younger staff down first, and the senior ones were kept away because we might get the virus. So our role is very supportive.

Q: I can imagine and as you said because of your experience with Operation Smile, you developed skills that are beyond your standard duties that can help.

A: In Operation Smile missions when you’re working in different countries, there’s a massive level of trust for those parents to hand the children over to us. It’s a different thing to caring for patients in the ICU, but it’s still a very personally challenging situation.

Q: What motivates you to continue fighting on the frontline?

A: Well, as a nurse, it’s a vocation to do whatever is necessary to ensure the safety and the best care of our patients, whatever the setting. On a personal level, the rewards of doing this kind of work can’t be put into words. It comes from the joy of seeing a patient recover after successful treatment. That’s our mission, whatever the setting.

Q: At Operation Smile we always have the happy ending, because of the type of activities that we do. I think that in this kind of situation it’s hard to see that sometimes you’re not able to provide a happy ending.

A: That’s right, but, in fact, you know, nursing isn’t always about happy endings. Sadly, it’s about many different sorts of endings. What’s fundamental for us is knowing that you’ve done your best to make the situation, however difficult it is, a little bit better for the patient and the family.

That’s the real joy of knowing you’ve done a good job.

Q: Can we talk about the Malawi programme because I know how much passion and experience you put into this programme. So can you just tell us if you feel like the training, the charity deed is helping local nurses to cope with Covid-19?

A: I’m sure it’s helping and I sincerely hope the planning and preparation skills we’ve taught them in setting up our clinical areas for Operation Smile, together with the techniques for delivering care, in particular, the aseptic techniques and techniques for the prevention of cross infection. These are vital skills for managing the effects of this pandemic and I hope that they’ve helped our nurses in Malawi. We planned to teach specialist skills in Malawi, but on top of a good basic foundation, basic techniques for prevention of infections. All those topics are all part of the training programme and they’re all techniques that can be used no matter what the subject is. So surgical or medical in the case of the pandemic, these skills are across the board and the aim of our programmes in Malawi is to teach the basic skills. I can’t wait to go back there. I was supposed to go for the long-term placement in April.

Operating room Nurse Dinah Leal, instructs at a scrub tech training programme. Operation Smile’s 2019 mission to Kazumu Central Hospital, Lilongwe. Malawi. Photo: Operation Smile - Zute Lightfoot.